04/11/2017 03:00 PM House HEALTH & SOCIAL SERVICES

         HB 159-OPIOIDS;PRESCRIPTIONS;DATABASE;LICENSES                                                                     
                                                                                                                                
3:07:44 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be HOUSE  BILL NO. 159, "An  Act relating to the  prescription of                                                               
opioids;  establishing  the  Voluntary Nonopioid  Directive  Act;                                                               
relating  to  the  controlled  substance  prescription  database;                                                               
relating to the  practice of dentistry; relating  to the practice                                                               
of medicine;  relating to the  practice of podiatry;  relating to                                                               
the practice of osteopathy; relating  to the practice of nursing;                                                               
relating to the  practice of optometry; relating  to the practice                                                               
of veterinary  medicine; related  to the duties  of the  Board of                                                               
Pharmacy; and providing for an effective date."                                                                                 
                                                                                                                                
3:08:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved  to adopt  the  proposed  committee                                                               
substitute (CS)  for HB 159, labeled  30-GH1021\J, Bruce, 4/6/17,                                                               
as the working draft.                                                                                                           
                                                                                                                                
CHAIR SPOHNHOLZ objected for discussion.                                                                                        
                                                                                                                                
3:08:34 PM                                                                                                                    
                                                                                                                                
JAY  BUTLER,   M.D.,  Chief  Medical   Officer/Director,  Central                                                               
Office,  Division of  Public Health  (DPH), Department  of Health                                                               
and Social  Services (DHSS), said  that Version J  incorporated 4                                                               
amendments to address the core intent  of HB 159 - to address the                                                               
floor of  legal prescription opioids in  Alaska's communities and                                                               
to  improve patient  safety.   The  first amendment  incorporated                                                               
under  Version J,  he noted,  would align  language under  HB 159                                                               
with the federal Comprehensive Addiction  and Recovery Act (CARA)                                                               
to allow partial prescription fills  without requiring voiding of                                                               
the remaining portion of the  prescriptions, as addressed on page                                                               
24, Section  8, of Version  J.   Second, Version J  would clarify                                                               
the role  and responsibilities of  the prescribing  providers and                                                               
pharmacists  filling   the  prescriptions.     He   stated,  "The                                                               
intention of  the bill all  along was that the  responsibility to                                                               
check [the] prescription drug monitoring  program (PDMP) prior to                                                               
writing  new prescriptions  for schedule  II and  III medications                                                               
falls to the prescribers; whereas  ... the responsibility for ...                                                               
populating  the prescription  drug  monitoring  program with  ...                                                               
unfilled prescriptions falls to the pharmacist."                                                                                
                                                                                                                                
DR. BUTLER  said the third  amendment made under Version  J would                                                               
address  the  implementation of  the  PDMP  update frequency;  it                                                               
would delay  implementation of daily  updates until July  2018 in                                                               
order to address  the potential administrative burden  on some of                                                               
the smaller pharmacies.   Finally, he said there  is an amendment                                                               
under  Version J  that  would clarify  the  liability waiver  for                                                               
advance directives  that include  not just failure  to administer                                                               
an opioid but  also the inadvertent administration  of opioids to                                                               
a person who has an  opioids advance directive on his/her medical                                                               
record.  He  said the related language is in  Section 31, on page                                                               
27, of Version J.                                                                                                               
                                                                                                                                
3:11:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD directed  attention to  page 28,                                                               
Sections 32  and 33,  and asked  for clarification  regarding the                                                               
justification  for  amended   language  related  to  correctional                                                               
facilities.                                                                                                                     
                                                                                                                                
3:11:46 PM                                                                                                                    
                                                                                                                                
DR. BUTLER replied  that the reason for  specifically calling out                                                               
correctional facilities is to make  clear the goal of the updated                                                               
PDMP  was never  to include  patients already  institutionalized.                                                               
He  said  much   of  the  focus  has  been  on   people  who  are                                                               
hospitalized.   He said it was  pointed out to his  division that                                                               
it  may  not  be  clear  that  people  who  are  in  correctional                                                               
facilities are  similarly institutionalized.   He said  he thinks                                                               
that what often  has driven the over prescription  of opioids has                                                               
been  misapplication  of  data on  hospitalized  patients,  which                                                               
shows people  in a hospital  receiving opioid medications  are at                                                               
remarkably  low risk  of having  subsequent  substance misuse  or                                                               
addiction  as  opposed to  those  who  receive  the drugs  on  an                                                               
outpatient basis.  He said the  change in language to include the                                                               
correctional facility  is to  clarify that  someone who  is begin                                                               
treated  in the  infirmary of  a correctional  facility during  a                                                               
prolonged   incarceration  is   being  viewed   similarly.     He                                                               
specified,  however,   that  someone  being  discharged   from  a                                                               
correctional  facility on  outpatient  opioids would  need to  be                                                               
monitored under the PDMP.                                                                                                       
                                                                                                                                
3:13:52 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ removed her objection  to the motion to adopt the                                                               
proposed  committee  substitute  (CS)  for HB  159,  labeled  30-                                                               
GH1021\J, Bruce,  4/6/17, as the  working draft.  There  being no                                                               
further  objection, Version  J was  before the  committee as  the                                                               
working draft.                                                                                                                  
                                                                                                                                
3:14:08 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ noted  that an  issue  had been  brought to  her                                                               
attention regarding  hospitals and emergency rooms  that dispense                                                               
less  than a  24-hour supply  of  opioids to  patients leaving  a                                                               
hospital.  She  said this relates to [Sections 32  and 33], about                                                               
which  Representative Sullivan-Leonard  just queried.   She  said                                                               
these supplies are dispensed as  prepackaged supplies of medicine                                                               
and requiring  such a  small supply  to be  reported to  the PDMP                                                               
would  be  an  "overly  onerous   burden  on  inpatient  hospital                                                               
pharmacies."                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ   moved  to  adopt  Amendment   1,  labeled  30-                                                               
GH1021\J.1, Bruce, 4/6/17, which read as follows:                                                                               
                                                                                                                                
     Page 28, lines 5 - 7:                                                                                                      
          Delete "those administered to a patient at a                                                                          
        health care facility or a correctional facility,                                                                    
      except when prescribing opioids to an inmate at the                                                                   
     time of the inmate's release"                                                                                          
          Insert "under the circumstances described in (u)                                                                  
     of this section [THOSE ADMINISTERED TO A PATIENT AT A                                                                  
     HEALTH CARE FACILITY]"                                                                                                     
                                                                                                                                
     Page 28, lines 13 - 15:                                                                                                    
          Delete "administered to a patient at a health                                                                         
     care facility or a correctional facility, except when                                                                  
      prescribing opioids to an inmate at the time of the                                                                   
     inmate's release"                                                                                                      
          Insert "dispensed or administered under the                                                                       
         circumstances described in (u) of this section                                                                     
     [ADMINISTERED TO A PATIENT AT A HEALTH CARE FACILITY]"                                                                     
                                                                                                                                
     Page 29, lines 7 - 9:                                                                                                      
          Delete "administered to a patient at a health                                                                         
     care facility or a correctional facility, except when                                                                      
      prescribing opioids to an inmate at the time of the                                                                       
     inmate's release"                                                                                                          
          Insert "dispensed or administered under the                                                                           
     circumstances described in (u) of this section"                                                                            
                                                                                                                                
     Page 32, line 22:                                                                                                          
          Delete "a new subsection"                                                                                             
          Insert "new subsections"                                                                                              
                                                                                                                                
     Page 32, following line 30:                                                                                                
     Insert a new subsection to read:                                                                                           
          "(u)  A practitioner or a pharmacist is not                                                                           
      required to comply with the requirements of (a) and                                                                       
     (b) of this section if a controlled substance is                                                                           
               (1) administered to a patient at                                                                                 
               (A)  a health care facility; or                                                                                  
               (B)  a correctional facility;                                                                                    
               (2)  dispensed to a patient for an                                                                               
     outpatient supply of 24 hours or less at a hospital                                                                        
               (A)  inpatient pharmacy; or                                                                                      
               (B)  emergency department."                                                                                      
                                                                                                                                
     Page 35, following line 11:                                                                                                
     Insert a new bill section to read:                                                                                         
       "* Sec. 51. Section 41 of this Act takes effect on                                                                     
       the effective date of secs. 21 and 23, ch. 25, SLA                                                                       
     2016."                                                                                                                     
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 35, line 15:                                                                                                          
          Delete "secs. 45 - 52"                                                                                                
     Insert "secs. 45 - 53"                                                                                                     
                                                                                                                                
CHAIR SPOHNHOLZ objected  for purposes of discussion.   She asked                                                               
Dr. Butler if he had seen Amendment 1.                                                                                          
                                                                                                                                
DR.  BUTLER said  he had  not seen  the text  of Amendment  1 but                                                               
understood  the  concept of  it.    In  response to  a  follow-up                                                               
question, he  reiterated that the focus  of HB 159 is  to address                                                               
the flood of  opioids into Alaska's communities,  and Amendment 1                                                               
would  address  small dispensing  of  medication.   He  said  the                                                               
current  law   surrounding  the   PDMP  does  not   require  that                                                               
prescribers "check the PDMP" if  dispensing less than a three-day                                                               
supply.   He said the  intent behind  this is to  incentivize the                                                               
subscription of  smaller amounts [of  opioids] and to  reduce the                                                               
administrative  burden.    He surmised  that  Amendment  1  could                                                               
achieve a similar  aim, as concerns the  administrative burden on                                                               
hospital  pharmacies, which  dispense small  amounts through  the                                                               
emergency  departments.   He  indicated  that the  administration                                                               
would not object [to Amendment 1].                                                                                              
                                                                                                                                
3:16:20 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ removed  her objection  to the  motion to  adopt                                                               
Amendment 1.   There being no further objection,  Amendment 1 was                                                               
adopted.                                                                                                                        
                                                                                                                                
3:16:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EDGMON  moved to  report  CSHB  159, Version  30-                                                               
GH1021\J,  Bruce,  4/6/17,  as amended,  out  of  committee  with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There  being no  objection, CSHB  159(HSS) was  moved from  House                                                               
Health and Social Services Standing Committee.